Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036.060334 | IL |
Y | 208D00000X | General Practice Physician | 036.060334 | IL |
NPI | 1023378684 |
---|---|
Provider Name | Odon D. Terrado |
First Address | Elmhurst, IL 60126-4844 |
Second Address | Elmhurst, IL 60126-4844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 16/05/2012 |